Impaired Distal Thermoregulation in Diabetes and Diabetic Polyneuropathy
OBJECTIVE: To determine how thermoregulation of the feet is affected by diabetes and diabetic polyneuropathy in both wakefulness and sleep. RESEARCH DESIGN AND METHODS: Normal subjects, diabetic subjects without neuropathy, diabetic subjects with small-fiber diabetic polyneuropathy, and those with a...
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| Veröffentlicht in: | Diabetes care 2009-04, Vol.32 (4), p.671-676 |
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| creator | Rutkove, Seward B Veves, Aristidis Mitsa, Theophano Nie, Rui Fogerson, Patricia M Garmirian, Lindsay P Nardin, Rachel A |
| description | OBJECTIVE: To determine how thermoregulation of the feet is affected by diabetes and diabetic polyneuropathy in both wakefulness and sleep. RESEARCH DESIGN AND METHODS: Normal subjects, diabetic subjects without neuropathy, diabetic subjects with small-fiber diabetic polyneuropathy, and those with advanced diabetic polyneuropathy were categorized based on neurological examination, nerve conduction studies, and quantitative sensory testing. Subjects underwent foot temperature monitoring using an iButton device attached to the foot and a second iButton for recording of ambient temperature. Socks and footwear were standardized, and subjects maintained an activity diary. Data were collected over a 32-h period and analyzed. RESULTS: A total of 39 normal subjects, 28 patients with diabetes but without diabetic polyneuropathy, 14 patients with isolated small-fiber diabetic polyneuropathy, and 27 patients with more advanced diabetic polyneuropathy participated. No consistent differences in foot temperature regulation between the four groups were identified during wakefulness. During sleep, however, multiple metrics revealed significant abnormalities in the diabetic patients. These included reduced mean foot temperature (P < 0.001), reduced maximal temperature (P < 0.001), increased rate of cooling (P < 0.001), as well as increased frequency of variation (P = 0.005), supporting that patients with diabetic polyneuropathy and even those with only diabetes but no diabetic polyneuropathy have impaired nocturnal thermoregulation. CONCLUSIONS: Nocturnal foot thermoregulation is impaired in patients with diabetes and diabetic polyneuropathy. Because neurons are highly temperature sensitive and because foot warming is part of the normal biology of sleep onset and maintenance, these findings suggest new potentially treatable mechanisms of diabetes-associated nocturnal pain and sleep disturbance. |
| doi_str_mv | 10.2337/dc08-1844 |
| format | Article |
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RESEARCH DESIGN AND METHODS: Normal subjects, diabetic subjects without neuropathy, diabetic subjects with small-fiber diabetic polyneuropathy, and those with advanced diabetic polyneuropathy were categorized based on neurological examination, nerve conduction studies, and quantitative sensory testing. Subjects underwent foot temperature monitoring using an iButton device attached to the foot and a second iButton for recording of ambient temperature. Socks and footwear were standardized, and subjects maintained an activity diary. Data were collected over a 32-h period and analyzed. RESULTS: A total of 39 normal subjects, 28 patients with diabetes but without diabetic polyneuropathy, 14 patients with isolated small-fiber diabetic polyneuropathy, and 27 patients with more advanced diabetic polyneuropathy participated. No consistent differences in foot temperature regulation between the four groups were identified during wakefulness. During sleep, however, multiple metrics revealed significant abnormalities in the diabetic patients. These included reduced mean foot temperature (P < 0.001), reduced maximal temperature (P < 0.001), increased rate of cooling (P < 0.001), as well as increased frequency of variation (P = 0.005), supporting that patients with diabetic polyneuropathy and even those with only diabetes but no diabetic polyneuropathy have impaired nocturnal thermoregulation. CONCLUSIONS: Nocturnal foot thermoregulation is impaired in patients with diabetes and diabetic polyneuropathy. Because neurons are highly temperature sensitive and because foot warming is part of the normal biology of sleep onset and maintenance, these findings suggest new potentially treatable mechanisms of diabetes-associated nocturnal pain and sleep disturbance.</description><identifier>ISSN: 0149-5992</identifier><identifier>EISSN: 1935-5548</identifier><identifier>DOI: 10.2337/dc08-1844</identifier><identifier>PMID: 19196899</identifier><identifier>CODEN: DICAD2</identifier><language>eng</language><publisher>Alexandria, VA: American Diabetes Association</publisher><subject>Adult ; Biological and medical sciences ; Body Temperature Regulation ; Circadian Rhythm ; Data analysis ; Diabetes ; Diabetes Mellitus - physiopathology ; Diabetes. Impaired glucose tolerance ; Diabetic foot ; Diabetic Neuropathies - classification ; Diabetic Neuropathies - physiopathology ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Equipment Design ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Feet ; Female ; Fibers ; Foot - physiology ; Homeostasis - physiology ; Humans ; Male ; Medical sciences ; Metabolic diseases ; Middle Aged ; Miscellaneous ; Monitoring systems ; Monitoring, Ambulatory - instrumentation ; Monitoring, Ambulatory - methods ; Motor Activity ; Movement ; Nerve Fibers - pathology ; Nerve Fibers - physiology ; Neural Conduction - physiology ; Original Research ; Patients ; Physical examinations ; Polyneuropathies ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Sensory perception ; Shoes ; Sleep ; Studies ; Temperature ; Wakefulness</subject><ispartof>Diabetes care, 2009-04, Vol.32 (4), p.671-676</ispartof><rights>2009 INIST-CNRS</rights><rights>COPYRIGHT 2009 American Diabetes Association</rights><rights>Copyright American Diabetes Association Apr 2009</rights><rights>2009 by the American Diabetes Association. 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c565t-cd528cde008411649bfec1beedc88d8f1c8107a3d82643465229afe8bb217ed33</citedby><cites>FETCH-LOGICAL-c565t-cd528cde008411649bfec1beedc88d8f1c8107a3d82643465229afe8bb217ed33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21324787$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19196899$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rutkove, Seward B</creatorcontrib><creatorcontrib>Veves, Aristidis</creatorcontrib><creatorcontrib>Mitsa, Theophano</creatorcontrib><creatorcontrib>Nie, Rui</creatorcontrib><creatorcontrib>Fogerson, Patricia M</creatorcontrib><creatorcontrib>Garmirian, Lindsay P</creatorcontrib><creatorcontrib>Nardin, Rachel A</creatorcontrib><title>Impaired Distal Thermoregulation in Diabetes and Diabetic Polyneuropathy</title><title>Diabetes care</title><addtitle>Diabetes Care</addtitle><description>OBJECTIVE: To determine how thermoregulation of the feet is affected by diabetes and diabetic polyneuropathy in both wakefulness and sleep. RESEARCH DESIGN AND METHODS: Normal subjects, diabetic subjects without neuropathy, diabetic subjects with small-fiber diabetic polyneuropathy, and those with advanced diabetic polyneuropathy were categorized based on neurological examination, nerve conduction studies, and quantitative sensory testing. Subjects underwent foot temperature monitoring using an iButton device attached to the foot and a second iButton for recording of ambient temperature. Socks and footwear were standardized, and subjects maintained an activity diary. Data were collected over a 32-h period and analyzed. RESULTS: A total of 39 normal subjects, 28 patients with diabetes but without diabetic polyneuropathy, 14 patients with isolated small-fiber diabetic polyneuropathy, and 27 patients with more advanced diabetic polyneuropathy participated. No consistent differences in foot temperature regulation between the four groups were identified during wakefulness. During sleep, however, multiple metrics revealed significant abnormalities in the diabetic patients. These included reduced mean foot temperature (P < 0.001), reduced maximal temperature (P < 0.001), increased rate of cooling (P < 0.001), as well as increased frequency of variation (P = 0.005), supporting that patients with diabetic polyneuropathy and even those with only diabetes but no diabetic polyneuropathy have impaired nocturnal thermoregulation. CONCLUSIONS: Nocturnal foot thermoregulation is impaired in patients with diabetes and diabetic polyneuropathy. Because neurons are highly temperature sensitive and because foot warming is part of the normal biology of sleep onset and maintenance, these findings suggest new potentially treatable mechanisms of diabetes-associated nocturnal pain and sleep disturbance.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Body Temperature Regulation</subject><subject>Circadian Rhythm</subject><subject>Data analysis</subject><subject>Diabetes</subject><subject>Diabetes Mellitus - physiopathology</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Diabetic foot</subject><subject>Diabetic Neuropathies - classification</subject><subject>Diabetic Neuropathies - physiopathology</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Equipment Design</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Feet</subject><subject>Female</subject><subject>Fibers</subject><subject>Foot - physiology</subject><subject>Homeostasis - physiology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Metabolic diseases</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Monitoring systems</subject><subject>Monitoring, Ambulatory - instrumentation</subject><subject>Monitoring, Ambulatory - methods</subject><subject>Motor Activity</subject><subject>Movement</subject><subject>Nerve Fibers - pathology</subject><subject>Nerve Fibers - physiology</subject><subject>Neural Conduction - physiology</subject><subject>Original Research</subject><subject>Patients</subject><subject>Physical examinations</subject><subject>Polyneuropathies</subject><subject>Public health. Hygiene</subject><subject>Public health. 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Impaired glucose tolerance</topic><topic>Diabetic foot</topic><topic>Diabetic Neuropathies - classification</topic><topic>Diabetic Neuropathies - physiopathology</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Equipment Design</topic><topic>Etiopathogenesis. Screening. Investigations. 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RESEARCH DESIGN AND METHODS: Normal subjects, diabetic subjects without neuropathy, diabetic subjects with small-fiber diabetic polyneuropathy, and those with advanced diabetic polyneuropathy were categorized based on neurological examination, nerve conduction studies, and quantitative sensory testing. Subjects underwent foot temperature monitoring using an iButton device attached to the foot and a second iButton for recording of ambient temperature. Socks and footwear were standardized, and subjects maintained an activity diary. Data were collected over a 32-h period and analyzed. RESULTS: A total of 39 normal subjects, 28 patients with diabetes but without diabetic polyneuropathy, 14 patients with isolated small-fiber diabetic polyneuropathy, and 27 patients with more advanced diabetic polyneuropathy participated. No consistent differences in foot temperature regulation between the four groups were identified during wakefulness. During sleep, however, multiple metrics revealed significant abnormalities in the diabetic patients. These included reduced mean foot temperature (P < 0.001), reduced maximal temperature (P < 0.001), increased rate of cooling (P < 0.001), as well as increased frequency of variation (P = 0.005), supporting that patients with diabetic polyneuropathy and even those with only diabetes but no diabetic polyneuropathy have impaired nocturnal thermoregulation. CONCLUSIONS: Nocturnal foot thermoregulation is impaired in patients with diabetes and diabetic polyneuropathy. Because neurons are highly temperature sensitive and because foot warming is part of the normal biology of sleep onset and maintenance, these findings suggest new potentially treatable mechanisms of diabetes-associated nocturnal pain and sleep disturbance.</abstract><cop>Alexandria, VA</cop><pub>American Diabetes Association</pub><pmid>19196899</pmid><doi>10.2337/dc08-1844</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Diabetes care, 2009-04, Vol.32 (4), p.671-676 |
| issn | 0149-5992 1935-5548 |
| language | eng |
| recordid | cdi_pascalfrancis_primary_21324787 |
| source | MEDLINE; EZB Electronic Journals Library |
| subjects | Adult Biological and medical sciences Body Temperature Regulation Circadian Rhythm Data analysis Diabetes Diabetes Mellitus - physiopathology Diabetes. Impaired glucose tolerance Diabetic foot Diabetic Neuropathies - classification Diabetic Neuropathies - physiopathology Endocrine pancreas. Apud cells (diseases) Endocrinopathies Equipment Design Etiopathogenesis. Screening. Investigations. Target tissue resistance Feet Female Fibers Foot - physiology Homeostasis - physiology Humans Male Medical sciences Metabolic diseases Middle Aged Miscellaneous Monitoring systems Monitoring, Ambulatory - instrumentation Monitoring, Ambulatory - methods Motor Activity Movement Nerve Fibers - pathology Nerve Fibers - physiology Neural Conduction - physiology Original Research Patients Physical examinations Polyneuropathies Public health. Hygiene Public health. Hygiene-occupational medicine Sensory perception Shoes Sleep Studies Temperature Wakefulness |
| title | Impaired Distal Thermoregulation in Diabetes and Diabetic Polyneuropathy |
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